Provider Demographics
NPI:1528043312
Name:GARZA, DANTE H (MD)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:H
Last Name:GARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2624
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902-2624
Mailing Address - Country:US
Mailing Address - Phone:361-576-3680
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:SUITE 102 W
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6004
Practice Address - Country:US
Practice Address - Phone:361-576-4164
Practice Address - Fax:361-576-4219
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDL3970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087JGOtherBCBS OF TX #
TX8AG481OtherBCBS OF TX
TX8F5669Medicare PIN
TX8AG481OtherBCBS OF TX
H66910Medicare UPIN